Spinal Deformity in Children with Cerebral Palsy: An Overview

Abstract

The most common spinal deformities involve scoliosis and primarily affect those individuals who are most severely involved, Gross Motor Function Classification System (GMFCS) IV and V. The spinal deformity usually causes a clear-cut, definite disability making seating difficult. There are other less common deformities of the pelvic spinal segment that all children with cerebral palsy (CP) are at some risk of developing such as pelvic obliquity, hyper kyphosis or hyper lordosis. The diagnosis and treatment of most spinal deformities is very clear, because if the deformity cannot be controlled with relatively simple seating adjustments, then surgery is the only definitive treatment available. The use of spinal orthotics or body jackets may improve seating ability but it does not impact the progression of the spinal deformity. Surgical stabilization and fusion for the spinal deformities are well defined. The fusion for children with cerebral palsy usually requires instrumentation from the pelvis to the upper thoracic spine. The surgical procedure may result in a number of complications, most of which do not impact the final outcome. From the perspective of families, the functional results of these procedures provide the best outcome of any operation that can be done in children with severe quadriplegic involvement. The goal of this chapter is to present an overview of the spinal deformities, the management and expected outcome. Algorithm for management of spinal deformities is also developed.